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Answering Clinical Research Questions with Health Records

Harnessing the scale and depth of linked electronic health records for research has the potential to change how healthcare is delivered and bring enormous benefits for patients.  

In this course we will introduce the breadth of the health informatics research agenda, focusing on the use of nationally available datasets for clinical research.  The course will cover the practicalities of health informatics research – from developing the research question through to methodology and obtaining research funding.
This course is ideal for individuals with a primary degree in healthcare who are interested in health informatics research but have either little or no experience in this area. 

Learning Objectives

By the end of the course, participants will:

  • Gain an overview of how health informatics can be used in clinical or population health research
  • Be aware of the main sources of data for research using health informatics
  • Understand the main methodological approaches required to analyse health records
  • Have an awareness of the main research and information governance issues relating to health informatics research
  • Understand the role of patient and public involvement in the health informatics research agenda
  • Identify funding streams relevant to research in this area

Planned Timetable

TimeTitle of sessionTutor
09:00-09:30Registration and coffee 
09:30-10:30

The scope of research using electronic health records Overview of the type and range of research studies that comprise EHR research.

  • Be able to identify different kinds of health and other related data
  • Understand the implications of the context in which health data are generated
  • Be aware of the key sources of curated and naïve (unprocessed) health and other related data
  • Identify the coding systems used by different key sources of health data and their strengths and limitations
  • Be able to identify the strengths and limitations of key sources of health and other related data
Professor Daniel Ray
10:30-11:30Introduction to electronic health records. How records are generated, content of EHRs, data sources, where to find different datasetsDr Julie George
11:30-11:45Coffee break 
11:45-12:45

Application of electronic health records to research questions.

Interactive session on matching research questions to the most appropriate study design (basic epidemiology knowledge assumed)

Explain common EHR study designs

Demonstrate when an EHR study design is appropriate

Evaluate the suitability of an EHR study design when applied to a research question

Dr Catherine Smith
12:45-13:45Lunch 
13:45-14:05Data access using the example of CPRDNatalie Fitzpatrick
14:05-15:05

Specialist methods for EHR studies. EHR specific problems and solutions including missing data, confounding and bias, phenotyping, data linkage, validation.

Aim: Learn to identify common issues in EHR studies

Objective 1: Introduce concepts for identifying and applying case definitions in EHR studies

Why EHR is different (thinking about case definitions)

Phenotyping (exposures, outcomes and covariates)

Objective 2: Introduce essential methodological considerations to reduce bias in studies with EHR

Dr Ruth Blackburn
15:05-15:20Coffee break 
15:20-16:00Ethics and research governance applied to EHR researchDr Nathan Lea
16:00-16:30Current and future developments in EHR research. Why big data is fundable nowDr Laura Shallcross

Course Team

Dr Laura Shallcross (Lead Tutor)

Laura Shallcross
Laura is a NIHR Clinical Lecturer in public health. She works jointly at the Institute of Health Informatics and the Department of Health, undertaking work on antimicrobial resistance and infectious disease epidemiology.
Dr Nathan Lea

Nathan Lea
Nathan is a Senior Research Associate at the UCL Institute of Health Informatics (IHI) working on projects in clinical care and research. His research interests include the role of information systems in supporting healthcare delivery and empowering patients, and Information Governance in the use of genetic, health and social care records in clinical research, particularly in the Age of Information and Big Data.

Nathan works on the Information Law and Governance In Clinical Practice and eHealth modules of the IHI’s Health Informatics MSc and courses in UCL’s MBBS. He has co-developed and deployed clinical information systems used at Whittington Health for Cardiovascular care and Dementia registries in partnership with the West London Mental Health Trust and UCL’s Dementia Research Centre.

Nathan works with the Institute of Health Informatics and is a member of the Innovative Governance Group. He sits on the Athena SWAN Self Assessment Team and UCL’s Security Working Group.

Prof Daniel Ray

Daniel has worked in health informatics for 18 years. He is Director of Data Science at NHS Digital where he is responsible for developing the organisation's data science capability, is the product owner of the new national data services platform, is head of profession of data management and leads a number of operational teams.

Prior to this he was director of informatics at a large teaching hospital in England, where he transformed the health informatics service, set up a quality outcomes research unit, and developed a patient portal among other work programmes. 

He has also setup commercial analytics businesses in England and abroad, including in Australia, the US and Italy. He has worked in commissioning in the NHS, the private sector and a number of other acute hospitals.

Daniel is honorary Professor of Health Informatics at UCL and the Institute of Health Informatics, where he gets involved in leading edge research and teaching.

Dr Julie George

Julie George
Taking a leave of absence from the NHS Public Health Training Scheme, Julie  is completing a PhD in clinical epidemiology, funded by an NIHR Doctoral Fellowship. Prior to joining the training programme in 2003, Julie held a range of different positions in academia and in the NHS.

Julie's PhD work focuses on gender differences in the development, treatment and outcomes of coronary disease, distinguishing between different initial symptomatic manifestations including stable angina, unheralded acute coronary syndrome and unheralded coronary death, using electronic patient records.  Collaborative work within the Clinical Epidemiology Group include investigating hospital variation in outcome following admission for acute coronary syndrome and developing the use of the CALIBER linked dataset.

Julie has assisted with the practical sessions for a variety of courses run by the Department of Epidemiology and Public Health. She has also lectured on using secondary data to MSc students. She is currently supervising the dissertation of student completing the MSc in Clinical and Experimental Science. With Stephen Bell, a fellow PhD student, she has organised the STATA Learning set for research students in the Department which aims to share learning and experience on using STATA efficiently.

Dr Catherine Smith

Catherine Smith
Catherina is an infectious disease epidemiologist currently working on an ESRC-funded programme grant, Preserving Antibiotics through Safe Stewardship. As part of this, she is running a large online community cohort study, Bug Watch, which aims to describe healthcare usage and antibiotic prescribing patterns amongst the general population in England for a range of acute common infections. She is also carrying out a study on the use of antibiotics in a large independent provider of care homes in the UK. 

Other projects that she have worked on recently include a randomised controlled trial assessing the use of a mobile app to support treatment of tuberculosis, and a study combining epidemiological information with whole genome sequencing to improve understanding of transmission of viruses in hospitals. 

In addition to epidemiological and statistical methods, she has expertise in geographic information systems and have developed interactive data visualisation tools to support infectious disease outbreak investigations. 

Natalie Fitzpatrick

Natalie Fitzpatrick
Natalie is responsible for enabling partnerships and collaboration between the Farr Institute and researchers seeking to use Farr data and resources, coordinating requests for accessing data, and providing advice and training on available data and infrastructure. Natalie also coordinates public engagement and communications activities for Farr London.  Natalie has more than 15 years’ research project management experience in cardiovascular diseases (recently an NIHR programme grant for applied research and HTA funded systematic review).  Natalie was responsible for establishing the Clinical Cohorts in Coronary disease Collaboration (4C), a DNA bio-resource linked to hospital EHRs, questionnaire data and health outcomes for 3345 consented patients recruited from 4 NHS Trusts across the UK, and member of GENIUS-CHD, an international consortium of 63 clinical cohorts containing CHD patients and DNA to associate genetic variants with subsequent events. 
Dr Ruth Blackburn

Ruth currently holds a post-doctoral UKRI Innovation Fellowship at the Institute of Health Informatics.  Her fellowship focuses on using data science to examine adolescent health behaviours in schools, particularly those relating to self-harm, violence, and drug or alcohol-use.

Her recent work has focused on measuring and addressing physical and mental health inequalities, particularly for vulnerable and hard-to-reach groups such as homeless people and women with substance misuse. She works with several teams, including the Administrative Data Research Centre for England (ADRC-E), Public Health England and UCL Infectious Disease Informatics, on a range projects relating to infectious disease control. These include integrating viral genomic data and hospital electronic health records to identify in-hospital transmission of influenza, and evaluating the role of bacterial and viral respiratory pathogens as triggers for acute vascular events.

She has a PhD in epidemiology, which formed part of the PRIMROSE program of work to predict and manage cardiovascular risk in people with severe mental illness, such as schizophrenia and bipolar disorder. Her PhD research used UK primary care data from The Health Improvement Network (THIN) to investigate inequalities in statin prescribing and provides the first estimates of the effectiveness of statins for reducing first myocardial infarction and stroke in people with severe mental illness.